1. aqihq.org Five Years of the AQI: What Do We Know About Ourselves Now? Richard P. Dutton, M.D. M.B.A. Executive Director

2. I am the Executive Director of the Anesthesia Quality Institute The AQI pays my salary I think the AQI is a good idea! © 2014 ANESTHESIA QUALITY INSTITUTE2 Disclosure

3. Provide the history and purpose of AQI Give an update on AQI progress and future goals Educate professional anesthesiologists © 2014 ANESTHESIA QUALITY INSTITUTE3 Agenda

4. The AQI Vision: To become the primary source for quality improvement in the clinical practice of anesthesiology Mission: To maintain AQI’s registries with case data as the primary resource for anesthesiologists looking to assess and improve patient care. © 2014 ANESTHESIA QUALITY INSTITUTE4

5. AQI-Who We Are Richard P. Dutton, M.D., M.B.A. o Executive Director Hubert Kordylewski, Ph.D. o System Architect Lance Mueller, M.S. o Director Adrian Liau, Ph.D. o Senior Research Associate Rico Turman, B.S. o Application Developer Jill Mlodoch, M.S.M. o Registry Manager © 2014 ANESTHESIA QUALITY INSTITUTE5

6. Benjamin Westlake, B.S. o Application Developer Debbie Novi, B.S. o Quality Division Assistant Antonio Sepulveda, B.S. o Application Developer Ashley Kieta, B.A. o Communications & Public Relations Associate Santana Sandoval, B.S. o Application Developer © 2014 ANESTHESIA QUALITY INSTITUTE6 AQI-Who We Are

7. © 2014 ANESTHESIA QUALITY INSTITUTE7 Miles Faciane –Application Developer Annette Antos –Quality and Regulatory Reporting Specialist AQI-Who We Are

8. AQI Registries © 2014 ANESTHESIA QUALITY INSTITUTE8 NACOR AIRS PPAI Closed Claims Project National Pain Registry

9. Putting on AIRS © 2014 ANESTHESIA QUALITY INSTITUTE9 Re-certified as a Patient Safety Organization > 1,300 cases 40 articles

10. www.aqiairs.org © 2014 ANESTHESIA QUALITY INSTITUTE10

11. NACOR: The National Anesthesia Clinical Outcomes Registry Participation at the practice level Every case, every day All available data Feedback via online reporting Certified for regulatory reporting The goal: Local Quality Improvement © 2014 ANESTHESIA QUALITY INSTITUTE11

12. 21 Million Cases Adding 2,500,000 cases per quarter Will capture 25% of all the anesthesia cases in the U.S. in 2014 The largest registry of its kind o Registry 2.0 – no abstraction or eyeballs o 34,000 Anesthesia Providers o 3,300 Facilities © 2014 ANESTHESIA QUALITY INSTITUTE12

13. What NACOR collects Administrative data20m cases Outcomes data4m AIMS data1m Hospital EHR datanone © 2014 ANESTHESIA QUALITY INSTITUTE13

14. Census Registry Participation © 2014 ANESTHESIA QUALITY INSTITUTE14 Sign Participation and Business Associates data use agreements Enter practice, provider, and facility information Registry participant runs case level data report Registry participant uploads data to the Registry Registry participant views reports

15. Census Registry Reports © 2014 ANESTHESIA QUALITY INSTITUTE15

16. Outcomes Reporting © 2014 ANESTHESIA QUALITY INSTITUTE16

17. Provider Level Report © 2014 ANESTHESIA QUALITY INSTITUTE17

18. NACOR Growth © 2014 ANESTHESIA QUALITY INSTITUTE18

19. Provider Distributions © 2014 ANESTHESIA QUALITY INSTITUTE19

20. Average Practice Size © 2014 ANESTHESIA QUALITY INSTITUTE20

21. Practices by Their Largest Facility © 2014 ANESTHESIA QUALITY INSTITUTE21

22. Anesthesiologists by Facility Type © 2014 ANESTHESIA QUALITY INSTITUTE22

23. Cases by Facility Type © 2014 ANESTHESIA QUALITY INSTITUTE23

24. Cases by Facility Type © 2014 ANESTHESIA QUALITY INSTITUTE24

25. Practice Income Source © 2014 ANESTHESIA QUALITY INSTITUTE25

26. Patient Distribution by Age and Gender © 2014 ANESTHESIA QUALITY INSTITUTE26

27. Patient Age Over Time © 2014 ANESTHESIA QUALITY INSTITUTE27

28. Outpatient Surgery © 2014 ANESTHESIA QUALITY INSTITUTE28

29. Monitored Anesthesia Care © 2014 ANESTHESIA QUALITY INSTITUTE29

30. Top 6 Cases by Patient Age © 2014 ANESTHESIA QUALITY INSTITUTE30

31. Cases by Facility Type © 2014 ANESTHESIA QUALITY INSTITUTE31

32. Procedures by Time © 2014 ANESTHESIA QUALITY INSTITUTE32

33. Cases by Facility by Time © 2014 ANESTHESIA QUALITY INSTITUTE33

34. Practice Benchmarking © 2014 ANESTHESIA QUALITY INSTITUTE34

35. Outcomes © 2014 ANESTHESIA QUALITY INSTITUTE35

36. Outcomes © 2014 ANESTHESIA QUALITY INSTITUTE36

37. Outcomes © 2014 ANESTHESIA QUALITY INSTITUTE37

38. Outcomes © 2014 ANESTHESIA QUALITY INSTITUTE38

39. Outcomes © 2014 ANESTHESIA QUALITY INSTITUTE39

40. Major Outcomes © 2014 ANESTHESIA QUALITY INSTITUTE40

41. Major Outcomes © 2014 ANESTHESIA QUALITY INSTITUTE41

42. Overall Outcomes © 2014 ANESTHESIA QUALITY INSTITUTE42

43. Practice Benchmarking © 2014 ANESTHESIA QUALITY INSTITUTE43

44. Practice Benchmarking © 2014 ANESTHESIA QUALITY INSTITUTE44

45. Changing National Practice © 2014 ANESTHESIA QUALITY INSTITUTE45

46. Outcomes in NACOR © 2014 ANESTHESIA QUALITY INSTITUTE46

47. Patient Satisfaction © 2014 ANESTHESIA QUALITY INSTITUTE47

48. AQI Educational Resources Nuts and bolts of quality management Outcomes of interest Data capture templates Anesthesia QM references and links List of acronyms Links to information technology vendors © 2014 ANESTHESIA QUALITY INSTITUTE48

49. MOCA--PPAI Addresses the Part IV requirements ABA approved modules available from ASA 13 modules now, more in the coming year “Customizable” QM project modules coming soon Clinical data from real-world practice AQI holds and aggregates the data © 2014 ANESTHESIA QUALITY INSTITUTE49

50. The Participant User File (PUF) The PUF file is a collection of all cases in NACOR The file contains de-identified patient demographic, billing, procedural, outcomes, clinical, and provider information, all in a single common format. Requires PUF request form to be completed and approved by the AQI © 2014 ANESTHESIA QUALITY INSTITUTE50

51. PUF-more © 2014 ANESTHESIA QUALITY INSTITUTE51 PUF is accompanied by a User Guide and a Data Dictionary The PUF is available in multiple download formats. PUF will require statistical software to open the file and do analytics. New version of PUF made available on a quarterly basis – includes a Readme.txt for specific information about this version of the file File is available for download on an FTP site. Credentials/instructions will be provided when PUF request is approved. We are creating a listserv community of approved PUF researchers.

52. Data Dictionary © 2014 ANESTHESIA QUALITY INSTITUTE52

53. PUF User Guide © 2014 ANESTHESIA QUALITY INSTITUTE53

54. Sample of PUF Data © 2014 ANESTHESIA QUALITY INSTITUTE54

55. AQI and MPOG The Multicenter Perioperative Outcomes Group Same data, different purposes: o AQI – Local quality improvement o MPOG – Research Joint participation encouraged o Shared formats, data elements Regular communication to ensure that requests for data wind up in the right place o The right data for the question o Avoidance of duplicative efforts © 2014 ANESTHESIA QUALITY INSTITUTE55

56. AQI and SCOR The SAMBA Clinical Outcomes Registry is becoming the AQI’s recommended ambulatory data module Multiple data collection methods o Stand-alone SCOR software o Abstraction from EHR Ambulatory specific benchmark reporting through SAMBA, to their members © 2014 ANESTHESIA QUALITY INSTITUTE56

57. AQI and STS/SCA Registry The Society for Thoracic Surgeons / Society for Cardiovascular Anesthesia Registry Granular case data collected by nurse abstractors, as part of the STS registry SCA has defined the data elements, and will assist STS in data analysis Analysis will benefit from STS risk adjustment model Do this if you can! © 2014 ANESTHESIA QUALITY INSTITUTE57

58. Maternal Quality Improvement Project MQIP: outcomes in childbirth A joint venture of ASA and ACOG AQI is the ‘Technical Vendor’ EHR built to collect structured data Direct transmission to Registry for 90% of desired fields Progress o Steering Committee o Advisory Committee o Data elements defined (first draft) o Epic build happening at University of Rochester © 2014 ANESTHESIA QUALITY INSTITUTE58

59. The NGO / WFSA Quality Project Began as a request to aggregate data from overseas trips by US anesthesiologists Request from WFSA Quality Committee to make it a template for local (international) use Agreement on data elements and format Templates up on AQI website Data collection mechanisms established o Paper > Scantron o Tablet > direct to cloud Stay tuned! © 2014 ANESTHESIA QUALITY INSTITUTE59

60. The Anesthesia Leadership Registry A database of individuals Jobs and titles outside the OR Contact information Linked to ASA Membership Data; ASA Practice Registry Uses: o National understanding of our “footprint” o Networking for existing leaders o Mentoring for new leaders © 2014 ANESTHESIA QUALITY INSTITUTE60

61. The Qualified Clinical Data Registry NACOR is a certified QCDR CMS Pay for Performance reporting for anesthesia practices and eligible providers Avoid penalties, qualify for incentives! 19 measures available in 2014; more in 2015 Practice must be participating in NACOR Reporting to CMS is free for ASA members; nominal cost for non-members Information available on the AQI website © 2014 ANESTHESIA QUALITY INSTITUTE61

62. Contact Us www.aqihq.org or r.dutton@asahq.org © 2014 ANESTHESIA QUALITY INSTITUTE62